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Who's ever typing? Can you mute? Yeah, that's me. Right. We are live fantastic. Um Welcome everyone to this first. Hopefully of many uh webinars that the let's do digital and the mind the be team and doing on digital health care. And this topic of this webinar is introduction to health informatics. There's many different names for this specialty, clinical informatics, health informatics, uh and so on. Um You pick your choice but basically how does digital and health care work together to make things hopefully better for the patients and the healthcare staff that are involved in said patients. Now, we've got three fantastic speakers with us today from very different backgrounds. Uh I'm going to let them all introduce themselves and then we'll kick off with some questions. Now, if anyone uh in the audience has any questions, please do ask them straight away and I will pick them out as we go along. We're not gonna have AQ and A at the end, this is quite an informal chat thing of us about like a chat down the pub. It's for you guys to find out about what are we about and how do we get here and how could you get here as well? And, you know, we can point you in the right directions to different things. Anyway, first of all, let's hear from Paul Drake. Mr Paul Drake, who's calling in from East Grinstead. Hi, everyone. Yeah. Uh, my name's Paul Drake. I'm a consultant, plastic surgeon. I'm the clinical lead of the burns service at East Guns and I'm the chief Clinical Information Officer. Fantastic. Thank you, Paul and Dom Main, uh, who's in London right now at his office in the little phone booth. Uh Can you tell us all about yourself? Well, this is the little phone booth. They just trapped me in here now. Um Hi, everybody. Nice to be here. Thanks, Mark. Um, so I'm a GP. Uh but I'm also a product manager and software engineer at Healthtech one and we do automation for primary care admin. Um, and I've basically just been a nurse since school and UNI and so I've tried to sort of combine all the different nurseries together. So nice to meet you. Fantastic. Um, definitely thumbs up for that one. Now, I'm not going to put thumbs up because apparently if you do your hand gestures on this system, it starts doing interesting light shows and stuff and maybe Don will just show you that when he gets a bit bored later. Oh, we like having fun here. We've got Chris as well. Who's joining us? Are you in Ireland at the moment. Uh That's right. Mark. Thank you. Yep. Chris Wilson here, I'm an NH SGP in Northern Ireland, uh and also a digital health fellow with Elephant Health Care who make um electronic health record software. Um So that's me. Fantastic. And I thought to give everyone a bit of an idea where I'm coming from. So I'm a local respiratory consultant and the condition of codes. Um Like the other three here, we were like, actually building things that we use uh in terms of functionality or data. I've just started a new company in London, a a bridge called Linder's Health uh working fantastically and we have very interesting stuff going on here. Um And just sort of further background is I used to be the Chair of the Faculty of Clinic Informatics and also a board member of the PCON or anyone else out there that's interested in Python, which is programming languages, language, just, you know, have a chat with myself and the team and we can sort of see where we can take things together, right? So, um yeah, if anyone has any questions, please do, just throw them into the chat. Um But I'm gonna start with Chris actually. Um what inspired you to pursue a career that combines both medicine and digital healthcare? Um Thanks, Mark. Well, I think uh I always like medicine because I enjoyed science and that seemed like a very good way to use it. And as I got to work in the N HSI realized that we could probably be using technology better um to help make the jobs easier. And so I always had an interest in tech, but um it was only in about 2015, I started teaching myself to code and then realized that you can actually do some quite useful things with this. Um And it sort of inspired me to uh to get involved from there. So I think the classic thing of seeing, seeing a problem or how things possibly could be better and, and imagining a solution. Not that it's always as simple as that, but II think that's what's inspired me. Yeah. Fantastic. Um, now Paul, um, you and me worked together for a short while last uh year when I was locating in the sleep department out there and I got to hear a lot about the interesting history at Queen Victoria Hospital in East for all the plastic surgery they did around sort of World War Two and so on. Uh, you as a plastic surgeon do things that I just can't even fathom. But I was just wondering what kind of trans skills did you get from, you know, your surgical training or plastic surgery and so on that helped you in the sort of digital landscape and you'll sort of see cio work as well in the hospital. Yeah, I mean, I'm not, I'm not sure what skills I missed a little bit of your question there. You see what skills from plastic surgery? Yeah, surgery and plastic surgery. What transferrable skills have you brought just from, you know, the area into this other world of digital health? I mean, I suppose a lot of it, there aren't any direct skills that you can bring across really, you know, surgery is a very practical specialty. Um, the, one of the things about plastic surgery is that it is very wide ranging. So we treat a whole range of conditions on every part of the body in adults and Children. Um So one of the, I suppose the transferrable skills is looking at how you can apply certain techniques to be reused. So, you know, plastic surgery isn't one operation for one thing. It's a, a whole host of techniques that can be used to solve problems in different ways. And I suppose that's where there's some parallel with, with digital health and with coding. Um because that's what it's all about, you know, you find, you know, what is the problem, what are the tools you've got to fix it with and what is going to be the best solution out of the four or five different options that you have? Um, so I suppose that's, that's one of the things that plastic surgery can bring to it. Um And in my role as the Chief Clinical Information Officer, that's, it's not a practical tech role. So in that role, I don't write code for anything I don't produce solutions. But what I do is provide assurance and governance and appraisal of what the best solutions are going to be and then how that's to be applied and implemented in the organization. Oh, very interesting. Um And for all those uh new people to the scene with digital health, the C CIO is the chief clinical informatics officer is basically the, the the boss of the, the shop, shall we say? It's the thing that everyone seems to aspire to. Uh there's a lot of work being done around the definition of who that is and what they do and the job description and the teaching around that as well. Um Now there are other sort of levels sort of around that. And we in the FC thematics, we talked about the office of the C CIO and all the other team members in there, but sort of the, the next level down. But I think try and keep a flat structure if you've got your CX IO. So X being, you know, PN and so and so pharmacists, nurses and so on. So you've got chief specialists as in not just medical specialties, but nursing, pharmacy, midwives and so on. Uh You have a CNO, don't you? At? Um If I remember is there any other um specialties you have? I can't remember. No, it's just um a CNO. So we have a, a Chief nursing Information officer and like I say, we try to keep that hierarchy completely flat. Um So, you know, we're not in charge of each other, but what we do is try and make sure we have a united front um and a very clear vision of what we want to do. Um So that we can provide the direction and assurance to the organization on all things digital and how it should be done. Fantastic. I have one more question for Paul and I haven't forgotten about you do at all. Um So I II know that you and Simon, your nurse, isn't it? Um are both interested in the program language are if you can talk to people about why you got into that and if in any way, it's helpful for what you're doing though, II think you kind of mentioned you're not really involved with the code but is it actually helpful in, in your sort of work as a clinical informatician? Yeah, I think um ra bit like Python is a very useful thing to know and I think um in some respects, it's sometimes a little bit easier to see why because R is fundamentally a statistical programming language. So anyone who's coming through university and medical training will have to learn some sort of statistics, even if it's just the basic stuff. And one of the benefits of art is that not only is it a statistical language, but it's also machine learning, mathematics, data visualization. Even web applications can be built in our and it's all using the same language, the same tools just with different packages and functions that you can use to build these things. So from my point of view, it's very useful because with one language, I can do all the data science stuff that I want to do. Um I can prepare presentations with interactive real time charts within them. I can produce a web app if I want to. And it's all from that same code base without having to learn something else. And it's not to say it's the only way to do it. There's always a lot of rivalry between R and Python, but of course, the, the two can work in tandem. Um And they both do their own things very well. Um In some respects, Python could be better for other stuff. Um And R is good for what it does, but it, it's an evolving ecosystem, it's a growing language, it's open source. So it really fits the scientific method paradigm. Um So, yeah, highly recommended. And of course, we have a thriving NHS R community which often has um NHS Python um links within it as well. Uh And they have a, a conference every year which is really well attended with lots of very interesting health related tech work going on. Fantastic. Thank you so much. Uh Paul, now do um over to you. So you and me met, oh, quite a few years ago, I think it's through the F ci and a sort of a common colleague that we both know, Doctor Anita F who should be listening right now. She tells me, um, uh, and you've been working at health tech one now for over, just under two years. Um I think we've discussed and it's really exciting. I had a, I had a visit to your offices, uh, a few months back. Really interesting what you're, you're doing out there. I was wondering if you could tell me or tell everyone that's listening a bit about the sort of automation stuff you're doing, which, you know, a lot we don't, there's a lot of admin stuff basically that USS have to do and I, you know, it can be boring, it could be tedious, it can be unsafe stuff that, you know, get wrong. We're just tired and repetitively saying yes. Yes. Yes, that blood test is fine and one of them is not, not. So if you tell me a bit about the sort of stuff you're doing at how, how you got involved with that and how it's improving, you know, patient care. Yeah, of course. Um Thanks Mark. So, uh, I guess, I mean, there's a few things in there aren't there? One is um automation as a kind of as a, as a thing. I mean, it's, it's kind of unsexy but, but basically a lot of the, a lot of the work we do is really repetitive and um as, as you say. And so if you're doing the same thing on times in a particular system, um then you can, you can make that somehow automatic with a few rules around it. Um, on a very basic level and a lot of the systems we work with in, in medicine are really bad, you know, and, but by systems, I don't just mean the hospitals, the whole, the sort of individual software packages and things that we have to use as clinicians day to day are very bad. I think the same is true in, in, you know, in the laboratories themselves or they, the software they have to use is from the nineties. Um, you know, they might have been when they were made when they first came out 1520 years ago. But, but now they, they are really quite terrible and coming from using modern software, modern websites and things. It's, it's, uh it's really quite frustrating how much they slow you down, you're trying to do work. Um And, and, and you're, you're being held back by terrible tools and that really kind of annoys me. I hate doing the same thing twice. Um And I was very motivated by kind of this feeling that that every single, you know, doctor obviously, you know, the GPS can relate directly to that. But, but other healthcare staff as well is, is kind of working at 50% or less capacity because of the systems that they're, they're having to use, it's not just software, but software's a big part of that and, and everything in some ways. Um you know, everything is data, everything is software. And so, you know, increasingly it will be true that, that, that will be held back by these limitations of these systems. Um And so I started tinkering around when I was working as a GP with kind of what I could do on my own system. And there's um I think the, the CTI those in the room might, might be, might get scared by this. So sorry, sorry, Paul. But there's um I wasn't sending any data anyway. So I think it's OK, but there's a, there's a, there's a tool called um uh auto hockey which is a, a great little, yeah. Marks, marks have used it. Yeah, it's a really um basic scripting language so you can write, it's, it's, it's code but it's, it's so basic that, that, you know, it, it, it, it is really very open to anyone playing with it. Um And what you can do is just automatic uh automate things like key presses and mouse clicks, you know, on bits of the screen or on certain parts of, of certain programs. Um And I realized that there were lots of things that, that I was doing in, in my clinical system when I was working every day as a GP that like six or seven mouse clicks every single time to do the same thing and, you know, it might sound like not very much, but if you do that 100 times a day, it really starts to drive you mad and it gives you RSI and, and, you know, I want to be angry at things that I can change, not things that I can't. So, um, so, uh, I, er, spent a bit of time genuinely, a couple of hours, like it probably, it was an hour over lunch one day and wrote, you know, a little script that, that gave me pock keys for all sorts of things in the clinical system. And it was like, both very satisfying but also really useful and I still use it, you know, whenever I'm in clinic and I've managed to get a few of my colleagues using it as well, but it's just things like getting control R and it'll, it'll bring up a referral template for you rather than having to click through four different buttons to get there. Um And then I was chatting about this to various people. Um And I did a bit of uh I'm not very good at networking, but I went to a few conferences when I was thinking about maybe, maybe kind of joining some health tech, you know, doing something in health tech. Um And I was chatting to a few people um and one of them, Anita who Mark mentioned actually put me in touch with um Doctor Lydia who works at Health Tere one as well when she's been, she's been on a break for a little while. Um who used to be at A X and I was going to speak to her for a bit of advice and, you know how I might sort of, you know, wiggle my way into health tech. Um and we talked about this automation stuff and then, and then it, that turned into, you know, why did you can work with us? Because we, we're also doing automation at health tech one, which is really cool. So I guess the moral there is that if you do things you're interested in um or that, you know, you think are worthwhile and then, you know, talk about them with, with the right people, they can sometimes open up opportunities to, to do more of the things that you're interested in, maybe even for a job, which is quite fun. Um Does that answer the question mark? I think you asked me a few things perfectly perfectly. Um And that's really interesting this, this if, if any of you guys met students and junior doctors or resident doctors now with um your name has changed, which I think is appropriate, of course. Um II, you will see there's a lot of health tech companies out there and it can be difficult to decide who to work for and who not to work for. And that's conversation in itself. And I won't dig into that. But there's quite a lot of interesting companies that the accurate is one of them who work mainly with GPS, but also secondary care. So hospitals and tertiary care, other hospitals as well. We have automating things. There's a lot of automating going on there now, you might, some, sometimes government says RPA or body process automation is A I, it's not just believe us, it's not, it's simply moving a mouse around the screen and clicking on things or typing something on the keyboard for you. It's just automating that whole thing. But AX has helped tremendously with the stuff it's doing around, you know, messaging patients and doing blood test and stuff like that and they've automated things really, really well. Um But I think everyone in the in the room here um from the conversation I had with you before I come across barriers when it comes to digital and enabling it and utilizing it. And so do and myself use this um auto hot key, uh which is a program that controls the mouse and so on to do things. But, you know, there's push back on using these things because there's worry about patient safety, about data cybersecurity and things like that. But do I just wonder if I can sort of get, you know, an overview from yourself of the barriers that you saw in GP land and sort of maybe the ways you've overcome it in your current role that's interesting. There weren't, I mean, in terms of kind of hacking around on my own computer, there weren't too many barriers, although you're sort of restricted from what you can install and your computer is really slow and, you know, if you, II know of a GP colleague who, who put some more ram in his, his, his NHS supplied computer to try and speed it up, which it did. But then when they found out they took it away and gave him another crap one to use. Um, so, so there are some barriers like that. Um, but, you know, the, the, the real problem was that II sort of made this little tool which was kind of useful, but, um, it was difficult to know how to sort of spread it around and how to ensure that it was like I could use it because I, I'd made it and, and the sort of rough edges were ok because II knew, you know, where it would go wrong and, and how to, how to kind of handle that. But, um, when you, when you want to, to spread something around and scale it to, to, you know, maybe every GP in the country, let's say you have to think very hard about what the risks are. So I'm also, um, one of the clinical safety officers that help it on which means I have to spend a lot of time thinking about the, the risks and what we produce, um, we don't use auto hockey. Sadly, actually I tell you lie, we do use it for one tiny thing, but we don't use it really in our, in our product, say, um, which doesn't say auto hockey is, is bad. But, um, but we had to kind of use other tools that are a bit more robust and that you can kind of, um, be a lot more sure about how they, how they behave in certain circumstances. And, you know, um I suppose what I'm, what I'm trying to say really is that you, there are different challenges when you're scaling to, you know, to a bigger population of users and that you can't, you can't, you have to build something that is as foolproof as you can make it even with, with uh very ingenious schools. Um and, and that, and that engaging people with on clinical safety really early is very important. So I really, you know, really grateful to the um clinical safety officers that at the, the GP Practices and I CBS and Federations that we work with for kind of basically reviewing our homework. Um You know, I produce all these documents that, you know, hazard logs and clinical safety case reports, which are quite dry, to be perfectly honest. But they're about basically, you know, what have we do, what, what does the program do? And it's, you know, very detailed flow chart. This is this, this is what we do, uh where do we think it can go wrong? Um And we have workshops to try and work out where we think it can go wrong, which is quite fun. Um And what have we done to try and mitigate that going wrong? Um And so these are, and, and, you know, organizations that we work with are justifiably really keen that we uh have made something safe and reliable and, and that won't, you know, that, that won't make mistakes or if it does make mistakes, at least that we have ways of catching them. Um, and so that's, I suppose that's a sort of a barrier but in a way it's actually, it, it's, you know, it's obviously a very important one. and it's a, it's a barrier we're glad to have. I don't know if that's what you're asking. But, um, but yeah. Um, yeah, and that's another role that, um, you, uh, from the audience will probably come across as the cso the clinical safety officer, a very important role, not everyone's cup of tea to do it, it can be very dry but very important. And if you have a good clinical safety officer who helps you navigate the whole difficulty around security, data safety and enables you to do it safely and secure and so on, they're a fantastic person to have on your team. It's difficult when they're always saying no, you can't do that. No, you can't do that. No. You can't do that. The computer says, no, that's hard work. But you've got a good CSI O, no, sorry. Uh CSO. And you know, those, a world of wonderful your projects talking about those sort of things coming over back to you, Chris. Um, I just wonder if I can get, sort of, I never got a feel exactly what sort of work you're doing at the moment in health tech is. But I wonder if, I don't know how much you can divulge if you've got non-disclosure. But I was wondering what kind of challenging projects you've been working on in, is the health care and what did you learn from it? Thanks, Mark. Yes, don't worry. Um No, no, significantly limiting. N da uh So I work with elephant healthcare who make electronic health records uh mainly in use in Nigeria, Kenya and Pakistan um at the moment. So um overseas territories. Um the, the interesting thing I found joining the company was they're coming from paper systems and uh people who have a wide range of, lots of people, for example, in Nigeria, our main market do have smartphones. Um but in their health care, it was all paper records. Um and we had to be faster and more convenient in paper and that turned out to be quite difficult because they had all the forms that the government needed for them to fill in. Um And to actually make that process quicker and easier for them took quite a bit of work. So that was my first introduction to user experience and got involved in some user interface design as well. Although I'm not naturally a designer, um and it showed just the importance of many, many different different roles. The the company also has a large operations team on the ground who are going into facilities. It's largely primary healthcare clinics, um especially in rural areas and um that sort of on the ground uh interaction with the end users that's been absolutely vital. I don't even think it would be possible to do it without that, to be honest. Um because getting to see how they use systems, how they overcome problems like power outages or poor connectivity. Um and then working around those um has, has been very challenging but very rewarding when you get it right and get good feedback from a facility. Um As an example in our web app, it's a web app service. Um they with cloud storage in the country. Um But they uh there were problems with poor connectivity. So we worked with the engineering team and made a lot of it offline. Um And with its thinking in the background and that was transformative for a lot of, a lot of clinics. Um And uh so, so I think it's shown just that the multidisciplinary working like we've alluded to before um in an NHS context, in a, in a sort of product context having the um a clinician which was me, designers, um developers, engineers and then the operations team as well as marketing and all of that. Um It's shown that it takes a lot of people to, to, to develop and scale a product with that has a good experience for the user. Um One of the most rewarding things for me was getting involved in finding the requirements for a antenatal care module and then developing um that in line with World Health Organization um guidance on optimal Antenatal care. So yeah, um very, very enjoyable, interesting. I come across um knowledge gaps in myself every day I work with them. Um And uh it has shown me a lot about interoperability standards and global health and, and touches on all sorts of other areas which has been absolutely fascinating. So uh it's not just um the code or, or that sort of thing, but um it's really broadened my horizons with uh with, with what goes into making a product. I think the question mark. Yeah. Uh and it's, yeah, there's quite a few questions come up from that, but one of them is II think you're still practicing. Is it four days a week and 11 day, one day in? So, um the first question is how do you balance that sort of different sort of mindset of? Here's this digital, digital thing, technical thing and then the other time GP practice and seeing patients and probably using difficult to use systems as well. How do you manage that sort of change of, um, you know. Yeah, it's, uh, it's literally, I quite enjoy the change. Uh, I'm, I'm naturally a jack of all trades, which is maybe why I ended up in general practice. I love the variety. Um, and I couldn't see myself doing something that wasn't varied. Um, but II find actually the, the working in different domains like that quite energizing actually. Um You right there are times when now that when I'm using my, my health record in my GP work, um I'll not name it, I think, oh, I would have done that differently, but I wonder why they did it that way. And then it opens up lots of questions as to why things are the way they are. There's only two to choose from it, flip a coin, there's only vision in Northern Ireland anyway. I'm not sure if it's different in England. Um But uh yeah. Um So it, it, it, it, it, it made me think, especially going, working in, in Africa. Um we're trying to help them. The quality of care can be very, very good, but we're trying to support them in getting the basics, right? And a really good quality of care that's equitable and accessible for everyone, which is, is one of the issues. Um So there were sometimes I wish the software that we used was simpler and didn't do as much. Um but was then much more accessible and easier to use so that all the members of the team used correct diagnostic coding and managed repeat prescribing the same way and, and all of this. So, um um so yeah, it, it's, I think what I've learned also doing general practice in the NHS has, has given me some insights into what a clinician needs from a health record software. Um And I think that has been very useful in my, in my private sector work. So I think there's a bit of a bit of interplay between the two, but ultimately, the variety I really quite enjoy. Yeah. No. Fantastic. Um Leading on for that, I'll come over to you Paul. Um Now I think we, yeah, we, we all have quite different um amounts of time we spend on the digital and so on. Um And C Cio S can have a range of time that they uh get given to work on these projects though. Normally they go over this allotment. So we have something called PS, you have uh 10 pa s. So it's basically a morning and afternoon session for things. And depending on how big a hospital is, you can have like the whole week that we sort of this CTO work. Um But normally you only get one or two, just a quick question to start with. How many, how much time do you get given for this work? And then after that, how much time do you actually do in digital? Yeah, you're absolutely right. In my contract, my C cio time is two pa s which amounts to one day a week, which I do on a Monday. Um, and, yeah, I spend a lot more time than that actually doing CC related work because there are always meetings that you have to attend or, you know, just other jobs that you need to do that you can't just fit into one day because as with a lot of things in medicine, but particularly in digital, um you don't work alone and you work with a very broad team. We're in the process of implementing an pr at the moment. So we've got project managers change leads, training people, configuration leads, configuration analysts, a whole range of people. Never mind the, the clinical staff, you have to use the system. So to try and make everyone available when I'm available is almost impossible. Uh So you do have to have a bit of flexibility. Um But equally, yeah, you do end up doing more than uh the, the allocated pa s that you, you have. Thank you. Um Now pr for everyone that was listening, electronic patient record system. Uh There's also er e hr it's all the same thing, health or medical. Um and it's the thing you'll be using your most uh when you come out of med school, um the GP practice, they have their own and in, in hospitals. There's many, many more. There's only two GP ones. There's three. Ok. But there's only two major ones. Um, and, uh, yeah, E pr s are, um, I could talk about for length about them how they're good and bad and all sorts. But I want to get your, uh, thoughts Paul on, you know how the clinician helps because you could just have someone who's, uh, software engineer and they build something and throw it at a clinician, which it feels like most of the time is what happens. But I want to get your take on how do you feel that a clinician plays a larger role in the design and implementation of health care technology? Yeah, I suppose that there are two aspects to that. There's one, how does a clinician contribute to the build and how does a clinician contribute to the implementation? And that, that follows the, if you like the kind of clinical safety framework because of course, there are two areas of legislation that you have to meet when you're developing digital products. One is the manufacturer's obligations and the other is the uh the organization's obligations of how they implement the solution. Um Obviously, if you design a system with the people who are actually intended to use it, you're far more likely to develop a solution that works for people who are going to use it. Um And in theory, this must happen, you know, we are implementing an ri can't believe for a second that clinicians weren't involved at some point in the design of that. Although when you actually see it, you really would wonder. Um But in particular, with the pr we have a lot of it is configurable. So a lot of the work that we will do over the next few months and probably the next few years will be configuring and refining and optimizing the solution to fit the work flows in our organization. And we're a very specific organization, unlike many trusts that people will encounter certain people on this call. We're the second smallest trust in the country and we only really have three specialties, four specialties on site. Um So we're very surgically focused uh with the sleep medicine, but a slight anomaly to that. Uh but everything is designed around getting people into and out of the hospital through a surgical pathway safely and efficiently, which is quite different to a hospital that's got a big ed in a large medical department, lots of medical wards. Um So a lot of the work I'll be doing is to try and tailor the solution that we've purchased to try and um enable that pathway to be as safe and efficient as possible and as easy to use for clinicians as possible. Because as we've alluded to a lot of the time, the systems we're given are very cumbersome. They involve lots of clicking or lots of other things that aren't the same program, they're different ones and trying to put all that together in a way that isn't painful. No, I think that's really important. And I'm a very big advocate of end user design, which basically means designing the system you use would be as easy to use as any app on your smartphone. You know, it's, it's just, it's intuitive, it's quick, it's smooth, it's flawless, it doesn't break and it does what you need as quickly as possible. Why we haven't got an app store for healthcare systems and people just choose the app they like and then that just, and the good apps will thrive and the bad apps won't, we haven't got anything like that. Maybe one day, maybe it's a bad idea. Who knows? Um But yeah, it's, it's all about building the functionality and the user experience. This thing you've seen on the screen and how it works is to work to work with us rather than against us. And unfortunately, when you get onto the wards and GP practices, you will see these systems that don't work that well and digital can enable and II fully believe this digital can enable better health care. It's just, we haven't realized it yet and it's a global issue. It has nothing to do with the UK, it's a global issue. Uh And there's many reasons why we haven't had those systems. Um I would not go into that. I built the way that we need them, you know, on a whole. But yeah, it's, it's, it's crazy. Uh Chris, I'll come back to you actually just leading on from this sort of discussion um around. So your uh digital work and even your healthcare work. I was wondering um how do you ensure that the digital health systems that you and your company build are accessible and equitable for all patients? You know, so everyone has the access to these things and you know, even those that are digitally illiterate, is that something you thought about or you know, the dexterity issues of, you know, the rheumatoid arthritis hands and all these sort of things which sometimes get left at the wayside. I was wondering sort of hear from yourself about what you've done to manage, you know, that accessibility and so on. Yeah. Thanks, Mark. Um Yeah, accessibility is so important if you're going to make something that can be used by anyone that needs to use it. Yeah, I suppose the two sides for the electronic health record are, are the the clinical user um which for our software can be anyone from a clinic, administrative person um to a nurse, a doctor um and, and various other roles as well such as a clinic manager. Um And uh the one issue we had is is we're starting from scratching a lot of the facilities from paper. Um So, and a very high variability of digital literacy. Um many clinicians were, were absolutely fine with, with using computers and tablets. Um many other people required additional training for that. So our operations team go in and provide training in the use of tablets and so on. Often the tablets are included as a package as well. Um And uh then with a lot of tablets, you will have various accessibility features such as magnifiers, text size variability and things like that. It also supports external keyboards for people who want that as well. So a range of of input devices with hopefully an intuitive and simple, quite a streamlined user interface which support assist technology. Um for example, like voice over if you have used that on, on, on iphones. Um So, so there's a, there's a sort of a multipronged um approach um for patients. Um We have there is AAA simple patient portal that's something that may well change and become more complete. Um And uh again, sort of dependent of course on access to computers which is or or or smartphone, which in itself can be uh not an equitable thing. Um And we had to decide that yes, this is for people who have access to that. Um But whatever that means, um because actually smartphone ownership is is quite prevalent there, but we had to make it again, simple um potentially Multilingual interface as well that can be selected. Um And again, with a few other accessibility, things like um um controlling the amount of information displayed and text size and so on. Um So thankfully, our designer has a lot of experience in making interfaces accessible and I'm glad they were in charge of that. Um Because that is an art form all in itself. Um And there have been many times actually, I've envied the simplicity of that interface when I'm using the BA that, that is my GP software. Um So, uh so yeah, sort of there was those two sides to a clinical but also patients as well. Um And we had to make sure as well that the software we were using didn't disadvantage certain patient groups. So um that was a bit more of a nebulous one perhaps. Um especially when we get into specific patient modules that we're not um you know, avoiding dealing with or providing functionality that supports the management of diseases just because they're difficult or just because we don't have them here in the UK, you know, um so managing problems like malaria and so on, which is a huge issue there. Um And uh again that in our case, it came down to a lot of work with the operations team, ensuring sort of equitable training and um even sort of patient outreach um around facilities that were, were implementing the software to make sure patients knew what it was that they had informed consent to use their data and information. Um And uh and that they were as on board as possible with uh with why it might be helpful to have an up to date record that they can access. So, yeah, hopefully that answers that word. Yeah. No, thank you so much. Thank you so much. Uh Now don um over to you uh a slight change of tech. So hopefully this doesn't take you off my guard. Um But I wonder if you could tell me a bit about the ethics around digital health care tools. We learn about ethics quite a lot at men's school. Um And then we kind of forget about it a bit but still use it here and there. But there's a lot of ethics behind, you know, digitizing things. A I and, you know, actually sending patient related data pseudo anonymize or however it is to the, you know, the, the, the the large language model that is C GBT and related models and other things. And I wonder if you tell me about the sort of ethics that you see that might be an issue or well or well managed even around digital health care. Yeah, that's nice. Yeah, there is a great example of this, you know, if we send out, let's say booking links by text message, that's great for maybe 60 70% of our patients. But there's quite a big chunk who just don't handle, don't handle technology well, um and are confused, frustrated or, or totally unable to, to reply to a text message or click on a link in in one, these things will change over time. But you know, that's, that's kind of really a really important aspect of building out a thing is thinking about the subset of users who won't, people who won't be able to use it and what, what the provisions are for them. Um There are lots of eth ethical things around digital health, right? Like there's, there's ethical considerations in doing less medical work and going to work as work as a start up. Um I may you doing four days a week as a Yeah, everyone slide off the camera four days a week as a GPI II just about manage one. And, you know, II frequently feel like I should do more but it's um it's really hard to kind of to, to find time for everything. Um And I remember when, you know, when I started here, I was like, I've just done all this, this training to be a doctor and now I'm gonna go do less of it. And I think, you know, on a personal level, I was like, maybe I can have more impact making kind of, you know, kind of tools and doing things here than I would as an individual GP. Um So there's that ethical consideration on a personal level. Um And you know, I suppose if you are making something that scales, you know, what we have 1000 GP practices of our customers now, uh which is about you know, 15% of the about 7, 6.5 1000 to 12, 6, 6100 GP practices in the country. So, um, stuff that we do has a huge impact. So we, we have a, an ethical GP to, to do a good job and, you know, to do all that clinical safety stuff we were talking about. Um, you know, to think very hard about, about how we do things. Um You also mentioned a I, we can, we can make this more of a chat. I don't have to feel like I'm doing a lecture. Um You know, uh I was actually thinking about A I earlier when um Paul, when you were talking about R and you know how powerful it was for you to be able to uh pull up, you know, make the website with an interactive demo and stuff like that. And I, I've been playing around a lot with um with one of the A I tools called Claude, which I'm sure many of you have already heard of. Um I like it because it, it, it has this thing called artifacts where if you ask to sort of, you can say, make me a, a little tool um to take this kind of data and, and, and produce a graph or make me an interactive tool to explore this data. Give it um either just like some sample data or, or you know what the actual data do you want to play with. Um, and then it will sort of whip up a little website which it puts in a demo demo page on the site. Sorry, I've veered off ethics, but this is really cool. So, no, no, please. If anyone listening hasn't played with this, try it out. Um, if you give it, yeah, there's the, the, the data format, you know, whether it's like a spreadsheet, you know, Excel style separated, um a spreadsheet format, tell it what you, what you want to do with it. Maybe it's just explore this data. Maybe it's, you know, break it down in these ways. It's really, really amazing at, at producing a little, you know, a little website tool, it'll show you the code and it'll, and it'll run it in the browser and then you can, you can tell it that you want to upload a, a data pass, then you're not actually giving all the data to the, the A I, you can download that web page and run it locally and then it avoids kind of risks about if you do have patient data on your end that you want to analyze or do something with, you can still get the A I to make you a tool that you can then use in a safe way. Um But if you are playing with uh with, you know, these A I tools, be very careful of what you feed into them. Um And don't give them, don't give them patient data because we don't really know where it's going. No. Exactly. Um So all these uh large language models actually use the data you give them to learn from. So don't put in anything that's patient related. Definitely. Um So we had a few questions on here. We'll catch up content, be uploaded later. So I think this is all being recorded. But if you want to learn anything more about what we're talking about or contact us, you can contact us at info at let's do digital.org or contact the mind the Beat team. I can put you in contact with Paul do or Chris. Uh if you want to get in contact with them and Marisol is asking about for clinical safety. What strategies are you using on Decommissioning systems? Thanks. I think there are some uh standards out there for doing it. I don't know if it's like a DCB standard out there. I don't know if anyone in the room knows how we decommission systems in a, in a standardized way. II haven't been involved in that myself. Yeah, it it depends really on what you mean by Decommissioning systems and clinical safety. As in the clinical safety framework is related to digital health products. So it's not, it's not related to hardware that's medical devices or your it equipment. So that's a different sort of Decommissioning, Decommissioning, a piece of clinical software. Really what it comes down to is where is the data, how is it going to be persistent or how is it going to be destroyed? Um And that falls into the DCB 0160 framework of implementation of clinical systems. So at the beginning of a project, um you actually decide how you're going to end the project as well. So um you always have to have a plan for where will the data be? How will it remain accessible if it can't remain accessible? Is it actually going to meet the rules on? For instance, if it's a health record, you have to purchase that record for a number of years and that number of years depends on what it's about. You know, if it's, if it's for pediatric conditions, that is often lifelong, whereas just standard stuff is usually seven years after the last contact. Um So there's an information governance aspect there, which is usually um helped by your Information Governance Officer. Um because the, the CX IO the Clinical Safety Officer and the information governance leads all tend to work pretty closely together because we all have just slightly different aspects of the same thing to deal with. So really the main strategy is to have the plan set out in your clinical safety case report in your case management file and it's different for different digital products. But if it's written out and well documented at the start, then it should be quite clearly open to governance and assurance at the end. Fantastic. Thank you. Um Paul. Now for the last section of um this webinar, I want to go on to education and learning how to get to where we are. I would say we us all here in the room are sort of midway through getting to the top or at the top even of being a clinical information. No, Chris and to say no, but II say Paul who's ACC O technically is at top. Um You know, you can be any higher if the National C Cio maybe as that or not. Um But II really like to get your thoughts. Um Paul on because you, you do teaching courses at R and so on. I would really like to get your thoughts on uh you know, we've got where we are, how, how do people listening now, you know, get to where we are or even start that process because I think all of us and everyone I've spoken to, um there's no career path for this. You kind of fall into it most of the time. You know, someone and you sort of get into this thing or you can code a bit and someone says, you know, you can fix the printer, you can fix the EP ri was just wondering if you could give sort of your thoughts on how people could actually get onto a career ladder in this specialty. Yeah, I think, I think you can summarize it by seeing stumbling in the dark. Um Because I think that's probably how most of us got through it. And I think given my vintage, I probably stumbled in a darker period than some of you. Um um, but I mean, I think it starts off with having an interest in it and developing some skills, whatever they may be and the skills you need, um, are very varied. You can be a C cio with no coding skills whatsoever because a lot of the CCI overall is about digital transformation, change management, education, providing assurance, understanding what the system should do and how they should be certified. Um But I think most of us have touched on things like coding or application design or website design at some point along the way. Um Most of what we've learned, we've learned by ourselves, either self taught or, you know, through coding communities, online courses, that sort of thing. And that's now more accessible than it has ever been in history. So, accessibility to learning how to do technical things with computers is around and it's very accessible. Um then to work out how to apply that stuff in healthcare, really the way I became ACC O was that I went to my predecessor and said, do you need some help? And he said, oh my God, yes, thank you. Yeah. One promptly retired and I got his post. Um but that's it. You know, it's, it's finding your way into the system. And if you're enthusiastic, if you've got some skills or some knowledge that you can apply, um then finding the person who does the job and asking you if you can help is probably your best bet. And then in terms of more formal training, um I did the NHS Digital Academy at the same time as Mark, which did provide some formal training in digital health leadership. And that's the, the CX IO rules are all about digital health leadership um rather than necessarily technical coding skills or um any sort of it skill. Uh So that does give um some legitimacy to what you're claiming to be able to do because you've actually been through it and yet you have a certificate at the end. So you got a bit of train. Um And yeah, and I'll just keep stumbling. That's how it feels. It does. Um But happy stumbling, maybe slightly tipsy stumbling, maybe that's the best way to describe it. Um Now, Chris, I'd like to come to you and the reason is because you and me kind of are practicing this, let's do digital tutoring and mentorship. Um So the, the, we, we used to have mentors uh in the FC, the fact of clinical informatics. Um and some thing we're doing at let's do digital and we're doing some coding course. If you're interested, we do a plug there at, let's do digital and Chris is helping us out do those courses in Python and learning how to use Python, you know, in health care. But I think the more general question I think is, you know, how can people find mentors or tutors and how can we help enable, you know, med students and doctors at the beginning of the career to actually progress in this specialty? Because unfortunately, there's no training number in clinical informatics. So you can't just sort of apply for training and get onto it. And then five years later, you're a clinical competition, C cio whatever. I, I'd really like to get your thoughts on how can we who are already on the this career path which doesn't really technically exist, you know, help others. Um Thanks, Mark. Um Yes, I found in my personal experience, II started learning to code, started with Python. Good place to start. Obviously, you don't have to learn to code um as we've said. But for me, that was interesting. And actually at the time, I was able to, I had a spreadsheet to keep track of the drugs in my medical bag. And then made that into an app because I never looked at the spreadsheets. And then the app told me when they were getting towards their expiry date. Um But for me, it started in that way and then I realized that this whole community out there. So II uh joined the Digital Health Networks, um the NHS PCOM community um the markets involved in um and uh and, and through just um observing conversations there, I got to know how that worked and then got to network with some people. So it was, it was sort of a, a slow organic thing in, in, in my case. Um And the one thing I would, I would say is, um I wish I'd probably started the journey earlier in, in my, in my medical career. Um But in terms of helping, I think the yes courses like let's do digital, you know, or even independent coding courses as well, you know, you know, starting out there or um digital Health Academy, you know, what I would say is on the ground in the NHS, speak to one of the information management team, I guess in your trust or your facility. Um The benefit there, I think would be, they can let you know what is being worked on where any help might be needed. And I think that's probably a quite a practical way that you might be able to get involved. Um So um approaching the local team, um I have to say until when I started out, I didn't know who the C CIO was for, it was Belfast Trust here at the time. Um But um now I find it better connected. So I think that networking getting to know some people getting involved in some of the online communities is, is vital. Um And there's a lot of knowledge sharing um can go on there as well. Um The, the NHS context in northern Ireland is a little bit different, but II then learned a lot about the um digital health in the NHS through a number of, of resources um largely through digital health networks. And there's a book I think by Gary mcallister that, that give a background to, to digital health in the NHS as well. So um there's a lot of, of resources there. Um So, yeah, II guess I haven't really addressed their sort of helping each other, but II think reaching out discussing it and, and finding how things operate locally for you. Um And where those opportunities are to get involved and then perhaps guiding your learning based on what your interest is or what way you want to get involved. Um And, and I, my t of message is that can be one of a number of different approaches or, or roles. Yeah, I think that's right. I mean, my, my experience at the moment is that um for instance, I have a trainee in anesthetics who expressed an interest in digital had obviously been discussing this with one of their consultant colleagues who said you need to go and speak to Paul because he's the C CIO. So he's now taken on a project and it was a project that had been sort of floundering a bit, but because he was new blood coming into the project hugely enthusiastic, um We have turned that around it's going to be going live very soon. Um It's a digital preassessment system, um which will be a huge benefit to the organization. Um But he would not have found that if he hadn't expressed his interest in digital, in conversations with the seniors who were then able to signpost him to the right person. So I think that is probably the key for actually getting any on the job, practical project experience. You need to find the team that are doing it in your trust or whatever organization you're working in. Um And then reach out, I think that's a really important take home message for anyone that's interested in this career path. Um I'll start using um is being proactive and actually going out there and asking can I get involved with a digital health program project however small or big? Because there's lots of them out there. The government's throwing money at this, basically, companies are throwing money at us basically uh for, for the better or worse. And if you want to get involved with this, just raise your hand, find people and talk to them and say I'm interested, I want to help and that's how most of us got into this. Um Now coming to back to you do. Um I think you and me and our colleagues, we have a little whatsapp group, have a lot of chats um in London and further a field about trends in digital health care. What's you know, what's sexy, what's not, what's happening, what's going forward. And I was wondering for, you know, people are listening, how can they best stay up to date with current trends, sort of, you know, try and understand what's actually, you know, snake oil, what is actually something that's beneficial to patients and healthcare staff? Um, you know, I just wonder if you can sort of elaborate on how you keep up to date and, you know, make sure you understand what's going on in the world in digital health care. Good question. Yeah, it's a really good question. Um, I think, I mean, ultimately it's curiosity, isn't it? And, and, and sort of reading a lot and being, you know, being kind of active on online and, and, you know, keeping your eyes open. But, um, you hinted at one that there's a couple of whats groups, there's, there's, um, you know, and the only way you'll find out about those is if you, if you speak to other people who are interested in the same things, so it really does come to it. I know it sounds awful, doesn't it? It really does come down to sort of networking in the end, which is a, I always thought was a bit of a dirty word. Um, but the only way you'll really hear about what's going on and on, you know, on the ground is from other people. Um, and there are, but there are some kind of central resources that the um uh what's it called? Digital Health Forums. If you got a link candy, you can take it in the, in the chat. That was um discourse. Yeah, exactly. The discourse um where I uh how I met Anita um who has come up a few times. Um But it's her fault. Yeah. Yeah, exactly. He basically got me my job and put me in touch with Mark as well in the first place. She's the great connector. But um but the discourse forums, a really great um place where all the lots of CTO S and, and some of those sort of people hang out and, and so lots of kind of new technologies are discussed on there, partly from a kind of roll out safety point of view, but also just from a curiosity and kind of experimenting with this, there's a, there's a clinic code section on there as well, which is where I met some good people. Um And, and then I think, you know, you, if you're sort of interested in tech, then there are, there are lots of kind of good resources for tech news. Like I really like the, the, the website hack news, which is uh it kind of like a standard sort of blog, like it like old school looking blog place where people post interesting tech news and um uh often that has a lot of that to do with A I or health stuff. So it has got a lot of crossover impact and that's always worth looking at in terms of what's snake oil and what's not. I don't know, I think you, you just have to keep your eyes peeled and develop a, I don't know, develop an intuition and therefore you must have seen a lot of snake oil in, in your Oh, yeah. And I continue to do so, I suppose the other thing, I don't know if anyone mentioned there's obviously digital health rewired each year, which digital health conference. Um and it's a good way to meet a bunch of people, meet a bunch of suppliers um and hear a number of talks over a very broad range of digital health topics and for people who are interested, if you're doing something interesting in digital health, then think about getting a poster or a presentation presented there because that's one way of getting yourself into the system. Um and being seen as uh someone interested in digital health. Yeah. Fantastic. Thank you. Uh both and uh let's do digital has a conference as well. Let's talk digital uh where you can submit um posters, video posters, we call posters. So you know, please come along to the one next summer. Oh, there it is. He did it. He finally did showed his true colors. Eight minutes. Very nice. Thank you so much. Um Thank you all. Um uh Yes. No, thank you. Um Paul and Don and Chris for coming along and telling about, you know, your lives, how you got to where you are and how other people could try and, you know, mimic what you've done. And I was thinking, I was just gonna hopefully end with a simple, um, answer from each of you a sentence, answer from each of you to this question, uh, and see how it goes. And we'll start with you, Paul. If you give your, um one piece of advice to your younger self as a junior doctor, what would it be in relation to digital health? C you start sooner? Fantastic. Uh Don. Yeah, I'm gonna, I'm sorry, I'm gonna steal that. I was gonna say less like go lesson full time and, and chat and find, find interesting things to do in the gaps and that would probably be talking to you finding out who's responsible for the digital stuff in your that you already work with and w we worm your way in there, intestate increase. Perfect. I would echo those sentiments start earlier. Um I didn't start learning to code until my early thirties. So um if you're younger than that, there is time, um I would say in your day to day work, looking out for a problem and thinking how you could solve it um is as a general approach, can be helpful um and can cultivate in you as sort of a mindset of, of just identifying, that's how often start ups are born is like, you know, um you know, or how change happens in something like the NHS is see a problem and work out a way to fix it. The rest of how that's done is often just then good bookkeeping, you know, and implementing it. But uh look for problems and think how they might be solved. So, yeah, and I'm going to ask myself that question as well and it would be reach out to people that are doing this and get involved. And that means II know I'm putting my hand up. If you want to contact me or anyone else in the room, please contact us. I II want to see more people doing what we're doing. There's not enough clinicians clinical ands out here to help make digital health better. A happy, happy note. I want to say thank you again to everyone that joined us from in the audience and Paul do and Chris. Um It's been great talking to you all and hope you have a nice evening and yeah, let's talk again later. Thanks everyone. Thanks everyone. Nice to see you all. Thank you, everybody. Catch you soon. Bye bye-bye time. Cheers guys. I'm gonna head off now. Thank you so much. Cool. Cheers Mark. Thanks. Thanks. Bye bye Dawn. See you.